ATLANTA -- State policies to limit teens' use of indoor tanning booths have been largely ineffective, researchers found.

Action Points

Explain to teens and their parents that indoor tanning accelerates aging of the skin and increases risk of skin cancer.

Note that the World Health Organization recommends restriction of indoor tanning use by individuals under age 18.

ATLANTA, Dec. 8 -- State policies to limit teens' use of indoor tanning booths have been largely ineffective, researchers found.

Indoor tanning prevalence by adolescents remained stable over time -- at 10% in 1998 and 11% in 2004 -- despite an increase from eight to 19 in the number of states with legislation restricting its use, Vilma Cokkinides, Ph.D., of the American Cancer Society here, and colleagues reported in the Jan. 1 issue of Cancer.

In the population-based surveys, the states with policies restricting minors' access to indoor tanning without parental permission tended not to see the same increase in prevalence as other states, but the difference was not statistically significant.

"The presence of state legislation restricting minors' access to indoor tanning appears to have limited effectiveness," the researchers wrote, "perhaps because most states' policies permit use with parental consent."

In their study, teens whose parents either used indoor tanning themselves or gave permission for their child to tan were substantially more likely to have done so (multivariate adjusted odds ratios 4.18, 95% confidence interval 2.20 to 7.90, and 15.42, 95% CI 8.94 to 26.60, respectively).

Although there may also have been too few states with policies to influence national rates, Dr. Cokkinides said, poor monitoring and enforcement of the policies is likely a larger concern.

The researchers recommended that physicians redouble efforts to inform parents about "the short-term and long-term skin cancer risks associated with the use of indoor tanning and the role they can play in assuring that their children do not use indoor tanning establishments."

Because indoor tanning beds typically deliver the same UV exposure as sunlight but in a more concentrated form, burns are common.

The self-reported burn rate was 57.5% among the 1,196 teens ages 11 to 18 surveyed in 1998 and the 1,613 surveyed in 2004 through the American Cancer Society's national population-based telephone survey.

Increased risk of skin cancer is particularly concerning among adolescents, the researchers said. One large meta-analysis found a 75% higher melanoma risk among individuals who started using sunbeds before age 35.

Indoor tanning also accelerates aging of the skin, alters immune system function, and causes photo-induced medication reactions, the researchers noted.

Many organizations support legislation to limit minors' access to indoor tanning facilities. The World Health Organization has called for outright restriction of use by individuals under age 18.

However, states typically make allowances for parental permission with only a few, such as California, limiting any use by children under 14 or 16, Dr. Cokkinides said.

To make indoor tanning as illegal for minors as buying tobacco products, though, is a complex political issue that interest groups have countered so far, she said. "There is a lot of room for improvement with a lot of these policies in a lot of these states."

In the unadjusted analysis, states with restrictions on teen tanning tended to have lower prevalence of past-year use than states without policies (OR 0.64, 95% CI 0.40 to 1.00).

But after controlling for predictors of indoor tanning use in youths, state policies had no impact on indoor tanning rates among adolescents (adjusted OR 0.77, 95% CI 0.43 to 1.39).

Factors that did significantly predict indoor tanning among surveyed teens in the multivariate analysis included:

Older age (ages 16 to 18 prevalence OR 4.26, 95% CI 1.91 to 9.47)

Female sex (prevalence OR 10.60, 95% CI 5.74 to 19.59)

Thinking a tan was attractive or looked healthy (prevalence OR 8.65, 95% CI 3.49 to 21.40)

A parent or guardian who used indoor tanning within the prior year (prevalence OR 4.18, 95% CI 2.20 to 7.90)

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